The subtypes of delusional disorder

As previously noted, DSM-IV recognizes five main subtypes of the illness based on the predominant delusional themes: the erotomanic, grandiose, jealous, persecutory and somatic, and mixed and unspecified types. ICD-10 also recognizes these subtypes, and adds litigious and self-referential. Here, the litigious variety is included under the persecutory group and self-referential cases are not given separate status since self-reference is, in a sense, a feature of the illness as a whole and prominent in all cases.

When delusional disorder was resurrected in DSM-IIIR, single delusional themes were emphasized, but the mixed category in DSM-IV accepts the reality that, for example, a hypochondriacal individual can also feel persecuted and an erotomanic patient can be extremely grandiose. Also, we shall find that there are considerable individual variations within the overall themes, so that in the somatic subtype there are cases involving different body systems. Yet the range of themes does not appear to be all that wide and we have no explanation for this relative restriction in their number. The 'unspecified' category in DSM-IV allows us to accommodate any case whose delusional theme is unusual and to be open to the discovery of other major themes in the future.

In presenting the subtypes, relatively more attention will be given to the somatic form. This should not be taken as an indication that this is the most common variant; rather, it happens to be the one which has been best documented in the recent psychiatric literature. Other types of delusional presentation are much more often described in non-psychiatric and non-medical sources, where the fundamental nature of the illness may be overlooked, and so we are only beginning to correlate such descriptions with modern findings on delusional disorder.

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.